So here we go.
Before we get started I feel I should
probably introduce myself and explain why I am further cluttering the internet
with sports injury help. As a physio student in my final year I have felt
occasionally you can be fighting a tough battle with patients when it comes to
self help information on the internet, this is in no means the patients fault. From
my limited experience I have found that a patient who takes an active interest
in their problem is going to rehab more successfully. However the success lies
on the accuracy and simplicity of the information given. Granted all the info
is out there, to allow a suitable rehabilitation process from an injury, for
the majority of niggles that the average evening pavement treaders and the
weekend trail warriors come up against. However sometimes it can be put across in
a non practical fashion that can lead to further complicating something that
could have been easily prevented. So that’s
the plan, rearrange the current information and hopefully add a few touches of
my own. As I am starting this now with 3 months left of my degree it may be an
interesting development of my own knowledge as well- which will probably result
in an uncomfortable read in a few years time when looking back. But never the
less on top of the posts I place up that I feel may be of interest please feel
free to email with specific questions or requests to posts.
adamrutterphysio@gmail.com
I am currently training for the London marathon in April. Therefore
I felt it would be fitting for the next week or so to add posts regarding
common running injuries. Which touch wood I am currently free from. As running itself is a fundamental aspect of
most sports it is not limited to road running/plodding so hopefully there is
some benefit to a wider sporting population.
Plantar Fasciitis
Straight to the business end of the runner. The picture
below shows exactly where I am referring too when discussing the plantar fascia.
To save any unnecessary reading on your part I will begin
with the potential signs and symptoms to allow you to make an informed guess as
to whether it is the plantar fascia that is causing your heel pain.
Signs and symptoms
·
PAIN- this is going to be the initial reason
that sparked your interest in self diagnosis, in the case of plantar fasciitis
the pain will be in the bottom of the foot with local pain on the bottom of
your heel
·
The pain may be brought on instantly when you
run, or after a short distance- it is likely that after the run the pain will
have increased. Usually patients would refer to it as an ache, or burning.
·
The pain is not exclusive to when you run. Walking
may cause the pain, some footwear may cause more discomfort than others. Are
your shoes offering you the support you need ??
·
Pain may be worse in the morning when you first
get out of bed. Overnight your movement
will be limited. Therefore inflammation may build up. As part of the body’s
natural inflammatory process chemicals arrive that the pain receptors in your
foot do not appreciate. Therefore your pain is greatest in the morning. This may
be exaggerated by a busy day previously. In some cases once you have been
moving the foot for a few minutes or showered the pain may decrease.
·
It may be tender to touch the underside of your
foot
·
The underside of your foot may feel generally
tight
What ?
If you are experiencing any of those
symptoms then you may find it interesting to read on.
Plantar fasciitis is an inflammation of the
thickened band of fibrous tissue that runs from your calcaneal tuberosity
(heel) through to your metatarsal heads. This tissue helps to support the arch
of your foot. Excessive stressing of the fascia can cause micro tears of the
tissue resulting in further pain.
The inflammation and pain is caused by overstretch and
overuse of the fascia.
This is generally down to other
underlying biomechanical issues
- Flat feet.
- Shoes with little support
- Weight gain
- Over pronation
- Tight plantar fascia (PF)/ gastroc-soleus complex
These underlying issues may have been with you for years
therefore not being the immediate reason for the pain (although they would need
correcting) it is when you couple the poor biomechanics with an increase in
load that your body starts to fail. For example- have you increased your mileage
recently? Changed your running shoe, perhaps to a more lightweight flat? Changed
running surface? Any one of these variants could be the straw that broke the proverbial
camel’s back (or caused your heel pain)
Advice
Exercise limitation is always a hard thing to advise-
especially when so much of physiotherapy is grounded in exercise prescription. However
cessation of the aggravating activity is the most sensible option. However don’t
take this as a professionally prescribed excuse to swap running for recumbence
or badminton for box sets, as there are many other activities to maintain your
fitness levels that limit the stress applied to your heel. Cycling and swimming
would be my personal suggestions as both are very low impact. However if the
heel pain is felt during the exercise, stop.
I feel it is important to split the advice given into 2 categories
to enable you to gain an understanding of why you are performing the activities.
Pain relief
|
Rehab
|
NSAID
|
PF stretch
|
Heel cups/insoles
|
Calf stretch
|
Limit use of high heels
|
PF strengthening
|
Ice massage
|
Appropriate choice of permanent insoles to encourage supinated foot
posture
|
Taping
|
Self massage
|
Night splint
|
|
Pain Relief
As it is an inflammatory condition it is paramount to get on
top of pain relief- specifically the inflammation. Therefore over the counter
NSAID such as ibuprofen can be beneficial when taken as the recommended dose.
A heel cup will help to reduce the impact on the tender area
during heel strike. Whereas an insole with help correct your potentially poor
foot posture which will aid the natural shock absorbing ability of your foot
and ankle
Boys and girls take a step down from the high heel for a
short while, you wont be looking too good in those lucky heels if your
grimacing the whole night.
Ice massage. I would advise to put a water bottle in the
freezer. Once its frozen place it under your foot and roll it for around 8
minutes. You will gain the beneficial effects of massage with this technique
Correctly taping your foot can provide immediate pain relief
for some patients by taking the tension off the PF
Rehab
This is the PF stretch, I would advise to stretch as far as
comfort allows, hold for 20 seconds. Attempt to perform 3-5 times a day
This stretch can be coupled with a standard calf stretch to
help to release some tension from the ankle, and to encourage a better foot
posture in the long term
To help strengthen the PF and the foot musculature place a sheet
under your foot, whilst sitting attempt to create a higher arch by scrunching
the sheet. Perform this 8-12 times. (Over the internet it is hard to prescribe
amount of reps, as people will fatigue at different levels) the one thing I would
stand by is work within the limits of pain.
Ideally insoles will be prescribed by a professional. But when
it comes to running it is vital to have your gait analysed to ensure you have
the right support to limit further injury with your running style. You can also
pick up insoles over the counter at chemists and sports shops. They may provide
you some relief.
Self massage is just a case of getting stuck in really. This
can be done with your hand or a selection of balls. As you can imagine the
massage pain will increase as you go from a tennis ball to squash ball to golf
ball. Have a play see what you like/ dislike. I expect this to feel
uncomfortable, but if it is making your pain significantly worse after the
massage reduce the pressure in which you are performing it.
It doesn’t stop there. Time to being pain free is very
variable. Some may experience pain reduction in a matter of weeks whereas for
others it may take months- even years.
However once you are pain free there are exercises you
should continue to perform to address the underlying issues we mentioned
earlier.
The gait analysis is the first step. This will allow you to
return to running safe in the knowledge that your feet a supported.
Take up bare foot running. This isn’t practical I appreciate.
However when your foot is in a running shoe the 26 muscles of your foot do not
have to work as hard to stabilise. Therefore taking it back to basics and
running barefoot is ideal; the most realistic way to perform this is on sand. With
the added difficulty of trawling through the soft sand your muscles will be
working harder than ever.
Alternate the running surface. Constant pounding
of the concrete can be taxing on your body not to mention the boredom
(personally). Mix it up find some grass, Forest tracks, or hit the dreaded treadmill.
There we go. I hope
you found some interest in this instalment. And remember this is in no way a
replacement for a professional assessment and treatment session. So if you have
any concerns get a referral.
Thank you
Adam Rutter